There is no stopping burnout, only mitigating it.
Now that I’ve discussed a couple of key points that I’ve identified in relating to physician and healthcare provider burnout. I wanted to talk about some things that we should be pushing for more to allow these lifechanging, literally, miracle workers actually have some peace of mind every once in a while. I think regardless of what you’re doing as your career, burnout is always a possibility, it’s just that different careers have varying amounts of pressure and responsibilities that inevitably lead to the differences in how prevalent burnout is in a career. Unfortunately, in medicine, even from the start, you’re essentially deprived of any meaningful work-life balance during medical school. Undergrad doesn’t really count because most everybody that has a white-collar career typically will have gone through an undergraduate education, but that’s not to say that those in the blue-collar workforce don’t face burnout either. In fact, I would believe that those who work in a more menial labor kind of career would also have high rates of burnout, but I haven’t had the chance to check the numbers. Regardless, mitigating burnout is a magically “new” concept that is now being explored in healthcare organizations, but then again it wasn’t really needed before, because now it is all about having more patients, more paperwork, with less time coupled with more stress.
- Physical and Emotional Exhaustion, being emotionally drained and feeling lifeless. Being so worn out by work and not able to recover in what little non-working hours you have.
- Depersonalization, as it sounds, it’s the feeling of not feeling like your original self. Not feeling the same as when you first started, of course it’s understandable that your feelings change as you really get into the nitty gritty of any profession, but it’s more about the development of a lackadaisical and even negative/cynical attitude towards patients and those that you work with.
- Reduced Sense of Personal Accomplishment, which is probably the most important to me is being unable to objectively understand the impact and effects that you are creating. I’ve always been told that if you do what you love, it would never be considered work, yet burnout could turn the one thing that you love into the most mind-numbingly and worthless job ever, which is the scary part.
But from the start of medical school, you learn to study and cram your life away for 1.5-2 years of didactic lectures and teaching. Sure, if you stay on top of your game and consistently work ahead to make sure you’re leaving yourself with free time, I can understand that you might not feel burnt out. But speaking to a couple of friends currently in this stage… it’s rough. You’re in class all day, study all night, cook, eat, sleep and repeat… some of these friends have to physically force themselves to go to the gym not because they’re trying to stay active and fit, but it’s to literally break the repetitive doldrum of studying all day… all with the added benefit of exercise. Then you fall into your years of being the lowliest person in a hospital round as you go through your rotations, completely disrespected by everybody and forced to do all of the grunt work as that “rotating med student”. I’ve been told that the initial years of medicine have been compared to the stereotypical pledging process of fraternities (though not all fraternities are like this! <3 Triangle) where you are the bottom of the totem pole, nay, you are the segment of the totem pole that has been dug into the ground. And with each passing year, you rise higher and higher, being exposed to more and more work as people think you become more and more competent in what you do. You get to your residency, where you’ll have your typical 80+ hour work weeks and days of being on-call. Then you have your fellowship, then you have your actual life as a doctor. It’s rough and the biggest reason why physician burnout happens is that all through those years, you simply have no work-life balance. It’s pretty simple to see, but from those that I know, it’s difficult to maintain a social circle, it’s difficult to be able to do other activities aside from medicine, and it’s just difficult to be able to even find time to relax. In fact, when I spoke to one of the doctors at a relatively recent pre-med conference in Chicago, they said “In medicine, it’s not called physician burnout. It’s called a human rights violation” that has led to some of the highest suicide rates among all of the careers, but because these are doctors that must provide emotional and intellectual support to many others, it is completely frowned upon to be able to take time off unless you’re laying on your death bed, especially when your missed work gets lumped onto an unsuspecting colleague. It’s already bad enough that you’re crumbling under an enormous burden of debt from medical school and lost potential wages, but now you have to work with poorly designed medical technology, and struggle with the frustrations of insurance, billables, and claims. As I mentioned before, all of this can lead to a decrease in medical care quality, increased numbers of medical errors and malpractice rates, lower patient satisfaction scores and metrics (that are used heavily against judging your performance), and unfortunately an increase in physician substance abuse, suicide, and just leaving the medical practice. That’s enough of being a negative nancy now… let’s talk about what we can do to try and prevent and mitigate this kind of damage though!
One of the most important things that should be done is creating a supportive environment, now I know that it is a lot easier said than done, but there needs to be a push towards organizations or just a committee within health organization that allows for struggling doctors to be able to reach out to and discuss the problems that they face without judgment. Unfortunately, there is an unfair stigma against “mental issues” in medicine that can lead to a Catch-22. In most job applications, there will always be a question(s) about the mental stability of the applicant, and honestly, who in the right mind would answer or check the “Yes” box because that’s basically asking for your application to be tossed into the trash. But if you answer no, despite having faced these mental issues of burnout, you’re possibly infringing upon an area of medical ethics reagarding the integrity of your decision :/. But if organizations didn’t ask this question and instead brought it up during an interview where it can allow the applicant the chance to explain their issue, it may be a better solution. But for those that are currently working, it’s important to be self-aware and mindful of “what you do? and why do you it?” to really “getcha getcha getcha getcha head in the game”. It’s important to find that “joy and passion” that we all set out with originally, and that doesn’t just apply to medicine… in general, we should always have a clear understanding of our motivations and allow that to give us the strength to continue on and more often than not, it’s just abotu being able to realign our thinking to highlight the more positive aspects of what we do and the impact that we can have for others. I once read, “Take every moment of your vacation time. Work hard, but play hard and that is the key to mitigating burnout”. The added burden of time and diversion of our energies from actual patient care is driving some physicians to earlier retirement and greatly adding to our stress, all without doing much of anything to enhance patient care. We need a new system, with one platform, focused on patient care and clinically relevant info. The bean counters should do the billing and coding, and leave us to our patients.
Here are some other keys to consider!
When you’re stuck in a specialization that is just work night and day, it’s difficult to ensure that you have a proper work-life balance, but the next big thing is being able to work with your healthcare organization in developing organizational prevention measures that can be used to help gauge the mental health and burnout progression for its employees, which in organizational terms, means better care, higher patient satisfaction, lower malpractice rates, and possibly, return visits… all of which means to “more moneh” $$$. In fact, I’ve heard stories of hospitals setting aside fully furnished break rooms to allow the healthcare providers to relax, a gym for them to stay active, as well as committees and programs that can allow healthcare providers a chance to anonymously talk to someone for help. It’s hard to give flexibility, and it’s hard to just give these providers time off, but what you can do is make sure that on their breaks and time off, they can fully take that time to relax and recover. At a hospital that is nearby, they have a great system that pairs with “traveling doctors” to ensure that when the healthcare providers decide to take time off, their work isn’t spread among their remaining colleagues and increasing their workload, but instead the hospital will bring one of these “traveling doctors” for the time being to ensure continuity of care! Burnout is waging a constant, soul-crushing battle on everybody, so it’s important that we can push for help together for everybody. But if that isn’t happening already, get the department organized with a strong group of physician leadership that can help the providers go toe to toe with hospital administration instead of being pushed around by the people that have no experience of what is really medicine. In a sense, it’s about finding the common ground between physician workflow and quality reporting for the hospital administration and if the common ground hasn’t been found, it’s important to keep pushing for regulatory changes and policy development that can help do that. In the end though, all that has to happen is that regulation and policies do not force physicians and other healthcare providers to practice bad medicine in a bad environment without the fear of negative consequences in speaking out. Here is a list of useful stress management techniques that I found from CareCloud:
- Start your day by relaxing. Instead of pouncing out of bed like frightened lemur, spend a few minutes meditating, doing gentle stretches, reading inspiring words or practicing breathing techniques. A proven yoga relaxation technique is called box breathing. Try it next time your feeling overwhelmed.
- Incorporate healthy eating, exercise and sleeping habits. Eating right, regular exercise and plenty of sleep will give you the energy to face a challenging day at the office. Also, promote healthy living at your office.
- Set personal boundaries. Don’t overextend yourself. Learn how to say “no” to certain things. If spending more time with your family is important, then always aim to leave work at a certain time.
- Take a break from technology. Set aside a few minutes a day where you completely disconnect from your laptop, cell phone and e-mail.
- Nurture your creative inclinations. Start a hobby that has nothing to do with work. Creativity can be a powerful ally against burnout.
- Rediscover the joy of practicing medicine. Take a moment to reconnect with the reason you got into medicine in the first place. Think back to a moment where you felt happy and appreciated. Write it down and strive to achieve that feeling at least once a day.
- Take time off. If burnout seems unavoidable, take a break from work. Go on vacation. Use the time off to recharge and gain perspective on your priorities. The world won’t end. We promise.